| NPI | 1134667462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27764) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN210232) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2024-03-15 |