| NPI | 1174097687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 23356) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 123069) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-11-04 |