| NPI | 1952077877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 33180) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 214786) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 141308) | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2023-03-27 |