| NPI | 1558827964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6384) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 808979) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2020-07-15 |