| NPI | 1770255259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 37926) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 237498) |
| Enumeration Date | 2021-10-02 |
| Last Update Date | 2025-01-22 |