| NPI | 1013373752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 619863) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 702305) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R219804) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2024-09-27 |