| NPI | 1659635217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 132744) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 98776) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012019388) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2018-11-29 |