| NPI | 1326145228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2288) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R28734) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-05-06 |