| NPI | 1114697463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 137088) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN197344) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2022-01-27 |