| NPI | 1760740682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2017016494) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP-144837) |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2022-07-21 |