| NPI | 1265997985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 69350) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 8752157-4406) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2021-12-15 |