| NPI | 1770138588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 128455) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN657028) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024190793) | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2026-03-03 |