| NPI | 1194364273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 71901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 0000222119) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2023-10-23 |