| NPI | 1881266948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25188) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: SC 212986) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2023-08-03 |