| NPI | 1528495520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18657) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 101301) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2023-04-19 |