| NPI | 1336684869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-131340) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1-131340) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2025-01-29 |