| NPI | 1447724679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22576) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 106872) |
| 207L00000X Anesthesiology (Licence: SC 22576) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2025-08-04 |