| NPI | 1629190251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 316106) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN088037 AP0488) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2025-07-25 |