| NPI | 1649209081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 11863) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 23882) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-02-09 |