| NPI | 1952977548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R42109) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND R42109) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-07-30 |