| NPI | 1952164600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2024023273) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019006750) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-06-27 |