| NPI | 1770310880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28287986A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN706204) |
| Enumeration Date | 2024-09-14 |
| Last Update Date | 2024-12-16 |