| NPI | 1659348233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N-26984) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-950) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2023-10-25 |