| NPI | 1598391435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 294796) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 294796) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10009609) | |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2023-08-17 |