| NPI | 1295155141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 286500000X Military Hospital (Licence: GA RN226805) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5886) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2025-02-05 |