| NPI | 1760876585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 21534) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9352102) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2024-07-08 |