| NPI | 1699848432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN532443) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R229506) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2024-04-02 |