| NPI | 1467318717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 335181) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN195961) |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2026-03-19 |