| NPI | 1518853712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 224707) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: OK R0137449) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-07-15 |