| NPI | 1215466081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 161299) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA193046) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2020-07-14 |