| NPI | 1497572150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10050803) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 315434) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2026-07-13 |