| NPI | 1013394717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 7828) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 111990) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2023-12-21 |