| NPI | 1013935964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7769) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 15967) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN094436-AP04472) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2025-08-22 |