| NPI | 1023123544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 354458) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24166459) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 1440339) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-07-24 |