| NPI | 1922439595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-106405) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA CRNA001579) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2025-06-11 |