| NPI | 1861639262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO C-APN.0003052-C-CRNA) |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2021-11-02 |