| NPI | 1326103490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 154494) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 154494) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-02-11 |