| NPI | 1447055157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 156422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0121343) |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-08-28 |