| NPI | 1861011082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1084058) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN291181) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006867) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2023-03-21 |