| NPI | 1336715549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 133571) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 28820) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2024-07-16 |