| NPI | 1922731199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 32400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000226738) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2023-02-13 |