| NPI | 1013354703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0945) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 76347) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2023-08-23 |