| NPI | 1275216822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4005360) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 36578) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-11-13 |