| NPI | 1669796496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 101687-06040) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA223050) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2022-08-23 |