| NPI | 1417624164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11015174) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 137245) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-10-08 |