| NPI | 1487015095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R191290) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10976) |
| 367H00000X Anesthesiologist Assistant (Licence: DE L6-0A10976) | |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2025-04-29 |