| NPI | 1669049052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 141139) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 253266) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2022-05-11 |