| NPI | 1932623683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9469917) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 2541) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 697520) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2019-02-25 |