| NPI | 1356730931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24178881) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 647655) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2021-01-11 |