| NPI | 1144280470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2006032655) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100561) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55374) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2025-10-22 |