| NPI | 1770212417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202214569CRNAPP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 239503) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-09-23 |