| NPI | 1306504006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 267210) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 217666) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2023-09-07 |