| NPI | 1851084693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11037206) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9551851) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2025-01-28 |