| NPI | 1316518913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6992) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 291641) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2022-09-29 |