| NPI | 1639440316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-58009) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R879866) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2020-01-13 |