| NPI | 1003380429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001692) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61080718) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0021021) | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2024-06-13 |