| NPI | 1316460751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R49397) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61428013) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2025-09-04 |