| NPI | 1750648317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN727728) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 89730) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2021-10-29 |