| NPI | 1306370101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018014375) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557485) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-03-16 |