| NPI | 1922755503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 33446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 195452) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2023-11-09 |