| NPI | 1700545183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024188556) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 225859) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7238) | |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2025-04-04 |