| NPI | 1528834553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 228128) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 361239) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2026-09-02 |