| NPI | 1619515939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 131335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 364746) |
| 163W00000X Registered Nurse (Licence: HI RN-60034) | |
| 163W00000X Registered Nurse (Licence: PA RN680561) | |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2024-11-13 |