| NPI | 1750044681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 232570) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 147680) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2024-01-08 |