| NPI | 1235514597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC001662) |
| Additional Taxonomies | 286500000X Military Hospital (Licence: AZ 1151) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2019-03-22 |