| NPI | 1558177170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1192132) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 770690) |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-03-06 |