| NPI | 1821794538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27653) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 124736) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-10-03 |