| NPI | 1003446360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 0823369) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 127310) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2020-03-12 |