| NPI | 1588253462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7397) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 239710) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 131967) | |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2026-06-09 |