| NPI | 1578300539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10028588) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10028588) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-09-18 |