| NPI | 1295378115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014637) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 01010101) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2021-01-21 |