| NPI | 1952091704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11012731) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 3868) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2024-09-22 |