| NPI | 1578243820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 34593) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 222392) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2026-01-20 |