| NPI | 1447505052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 1797) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 091089) |
| 163W00000X Registered Nurse (Licence: NC 216669) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2025-09-22 |