| NPI | 1639722770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 76514) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002958) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 200475) | |
| 367H00000X Anesthesiologist Assistant (Licence: OK 200475) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-10-25 |