| NPI | 1487640942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10584) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 071188) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2024-12-11 |