| NPI | 1790167096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024178446) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR13955500) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R189101) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2019-11-07 |