| NPI | 1861796583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA RN00149713) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005695) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1073750) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 621725) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2025-10-05 |