| NPI | 1407926249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 205234) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 068184) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-12-04 |