| NPI | 1861175812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024191365) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R098768) |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2025-03-04 |