| NPI | 1598441594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 14083) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 143317) |
| 363L00000X Nurse Practitioner (Licence: WI 14083-33) | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-08-25 |