| NPI | 1518758366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 15006) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 00000000000000000000) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-07-02 |