| NPI | 1801191168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169402) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 620584) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2025-03-18 |