| NPI | 1639719008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 141203) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: PA 723602) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2025-02-13 |