| NPI | 1457367518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 580) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 77969) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-01-20 |