| NPI | 1023526522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3016423) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 119587) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2021-09-16 |