| NPI | 1366272569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24190688) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R218552) |
| Enumeration Date | 2024-08-03 |
| Last Update Date | 2024-08-03 |