| NPI | 1669562658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2025008082) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R52164) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-04-09 |