| NPI | 1811622392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 324800) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1095999) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10027429) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 227281) | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2025-12-18 |