| NPI | 1073998159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 6964) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 617571) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2025-07-14 |