| NPI | 1053842682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 576730-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 576730) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2023-09-29 |