| NPI | 1427931740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 328223) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000239282) |
| Enumeration Date | 2025-07-26 |
| Last Update Date | 2025-09-17 |