| NPI | 1659511970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10005021) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 004000) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2023-03-09 |