| NPI | 1508513870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1098138) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9545659) |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2023-03-28 |