| NPI | 1750998696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3018889) |
| Additional Taxonomies | 163WS0200X Registered Nurse School (Licence: KY 1139550) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-01-12 |