| NPI | 1871857979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 841918) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 261320) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000396) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-03-02 |