| NPI | 1366106924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 38073) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN252446) |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2025-02-28 |