| NPI | 1396431557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 17159-33) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 146724) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2025-07-29 |