| NPI | 1124070719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R863777) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04871) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN113738) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-02-14 |