| NPI | 1770352973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC006284) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 307349) |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2024-02-22 |