| NPI | 1538807771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 010660) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 137393) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-07-07 |