| NPI | 1992504518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 336235) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 153333) |
| 163W00000X Registered Nurse (Licence: PA RN770409) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 714705) | |
| 163W00000X Registered Nurse (Licence: NY 714705) | |
| Enumeration Date | 2025-03-08 |
| Last Update Date | 2026-04-29 |