| NPI | 1083241467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25719) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 220272) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2022-01-31 |