| NPI | 1285122820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 53324) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 121906) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2021-04-26 |