| NPI | 1013935964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN094436-AP04472) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 15967) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-10-21 |