| NPI | 1538872791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 211275) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0126530) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2023-01-11 |