| NPI | 1033552518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2013008912) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 3121) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2022-05-16 |