| NPI | 1124265590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 121197) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 47932) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2021-07-08 |