| NPI | 1700048477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 69416) |
| Additional Taxonomies | 261QP0904X Clinic/Center, Public Health, Federal |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2024-01-16 |