| NPI | 1164032249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA246519) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 126819) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2021-07-22 |