| NPI | 1881250835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6159) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN194149) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 194149) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2023-04-13 |