| NPI | 1508339391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 140013) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-140013) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2025-04-29 |