| NPI | 1609575216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4041650) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9452369) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0021301) | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2025-06-24 |