| NPI | 1497227797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24769) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 214261) |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2021-12-07 |