| NPI | 1790876308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 85699) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 075833) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-08-07 |