| NPI | 1750725594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 268343) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 866601) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2023-09-19 |