| NPI | 1891286027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 58410) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 121803) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2023-11-01 |