| NPI | 1588656235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0030656) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 33243) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-02-06 |