| NPI | 1285405126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 78477) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 3007) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-07-31 |