| NPI | 1215069877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-557A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: ID rna-557) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2019-08-23 |