| NPI | 1750342366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179663) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 161637) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN161637) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-02-10 |