| NPI | 1083165583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 314881) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D169092) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557937-091) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1057177) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901407) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2025-08-19 |