| NPI | 1710091533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK NURA442) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100700) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2023-06-15 |