| NPI | 1730807207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN315848) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95106383) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 958121) | |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-10-17 |