| NPI | 1043809726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 802492) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 1027310) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 317196) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1027310) | |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2025-10-07 |