| NPI | 1093031874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 206095) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101117) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2023-06-20 |