| NPI | 1538096763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 201098) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: LA 25254285) |
| Enumeration Date | 2026-05-04 |
| Last Update Date | 2026-06-12 |