| NPI | 1023018454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167982) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 0024167982) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-03-08 |