| NPI | 1578290136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 71231) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 872659) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2024-12-05 |