| NPI | 1922422708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024183174) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 780164) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2022-05-13 |