| NPI | 1417400896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 42573) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R901362) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2026-07-21 |