| NPI | 1811676489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10041275) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9494883) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 301627) | |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2026-07-20 |