| NPI | 1912397589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN610229) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 106057) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2022-04-07 |