| NPI | 1740937176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7505) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001257174) |
| 207L00000X Anesthesiology (Licence: SC 27282) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27282) | |
| Enumeration Date | 2022-03-06 |
| Last Update Date | 2024-10-04 |