| NPI | 1497770788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-00587) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 20421) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-06-25 |