| NPI | 1285875443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0082952) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 14006) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2024-11-07 |