| NPI | 1194775791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 2401) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 102664) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02854) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-01-08 |