| NPI | 1982724779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024187094) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 146305) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-05-22 |