| NPI | 1225023278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 194240) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 118864) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2024-07-24 |