| NPI | 1821744210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 306227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9461979) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11032844) | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2025-08-29 |