| NPI | 1285404053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 216547) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1148571) |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-05-13 |