| NPI | 1740967629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 145668) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OK 122359) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-11-29 |