| NPI | 1336759679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 72208) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 223425) |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2023-10-20 |