| NPI | 1093468662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024188964) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 1068497) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1068497) | |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2025-01-21 |