| NPI | 1295029197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25237) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 210260) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2021-11-16 |