| NPI | 1962157784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11018390) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9510181) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2024-10-04 |