| NPI | 1659889327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000536) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 8891319-4406) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2021-10-26 |