| NPI | 1619756699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 300668) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 151133) |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2024-03-01 |