| NPI | 1659333201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 91549-30) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 231-33) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2020-12-27 |