| NPI | 1790387520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61399488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 981448) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2024-04-01 |