| NPI | 1730460361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007135) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 34124) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2024-01-05 |