| NPI | 1114396975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 077575-23) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0115633) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2023-12-04 |