| NPI | 1770180754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID CS66320) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9039291-3102) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R54844) | |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2023-09-18 |