| NPI | 1659755296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0994096-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 94571) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2025-06-17 |