| NPI | 1306891452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 3406) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: CT 003406) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-07-10 |