| NPI | 1578349916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.1000888-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1016010) |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2025-07-22 |