| NPI | 1013401157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 639986) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 123824) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-09-06 |