| NPI | 1558458042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 2163) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 136101) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2025-06-19 |