| NPI | 1932624152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 007129) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 007129) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2018-10-09 |