| NPI | 1326196015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R197947) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 551128) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2024-05-13 |