| NPI | 1649052606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 200677) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 201807) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2026-09-28 |