| NPI | 1922756683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11024587) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9462438) |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2026-04-28 |