| NPI | 1851964720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2350338) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 176199) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1164864) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2025-10-10 |