| NPI | 1851286108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14885) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 186997) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-10 |