| NPI | 1619563947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10007858) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 000022863) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2023-06-16 |