| NPI | 1891383626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 870587) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 47035) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-08-15 |