| NPI | 1982411997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 221872) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 960503) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1188825) | |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2025-06-10 |