| NPI | 1558460295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015043775) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01497) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2025-01-22 |