| NPI | 1063418200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN135363) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55340) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-085935) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-09-09 |