| NPI | 1568670230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C001436) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MO 2005035297) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-07-16 |