| NPI | 1730514993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016033441) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101222) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2022-02-03 |