| NPI | 1619630647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 76725) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 51767) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 136302) | |
| Enumeration Date | 2021-10-17 |
| Last Update Date | 2023-10-23 |