| NPI | 1265108369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2831) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 228052) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D176196) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR001128) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2023-12-28 |