| NPI | 1902641954 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 327026) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001240572) | 
| Enumeration Date | 2024-06-29 | 
| Last Update Date | 2025-08-29 |