| NPI | 1518426956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME114604) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11001917) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2023-01-05 |