| NPI | 1952388084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP01617) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 32576) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-05-05 |