| NPI | 1063961928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9902165-8901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9902165-4406) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2022-11-11 |