| NPI | 1326520461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5953) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 124084) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-03-06 |