| NPI | 1457994063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9409550) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 090884-23) |
| Enumeration Date | 2019-10-26 |
| Last Update Date | 2023-04-20 |