| NPI | 1942994694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7271) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 275107) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-11-17 |