| NPI | 1578927935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60660939) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GU 100429) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2025-06-09 |