| NPI | 1770368052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 158227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 212270) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2026-06-01 |