| NPI | 1447980347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 867115) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 100110) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-07-28 |