| NPI | 1679257927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11027970) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 110085) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-02-16 |