| NPI | 1427739879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11041160) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 98365-G) |
| 163W00000X Registered Nurse (Licence: NJ 26NR19557300) | |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2025-10-15 |