| NPI | 1962383174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 157305) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 91584) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2026-02-18 |