| NPI | 1225030372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-090700) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901401) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26371) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-05-08 |