| NPI | 1821509753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557524) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D170072) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2025-07-15 |