| NPI | 1770255135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 152384) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000235095) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2025-01-20 |