| NPI | 1215265400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 307056) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 359) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2024-10-30 |