| NPI | 1730859661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30945) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 233768) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2026-02-13 |