| NPI | 1942715412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 240773) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 076895-21) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2020-04-30 |