| NPI | 1609552066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4041758) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 268168) |
| 163W00000X Registered Nurse (Licence: KY 1162866) | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-06-13 |