| NPI | 1053044891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD cr001119) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SD R042289) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-08-25 |