| NPI | 1609033034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P2432) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 0031943) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX P2432) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-06-22 |