| NPI | 1043879505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 115461) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 115461) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-02-19 |