| NPI | 1083038319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 568551) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: PA 20821501) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2022-02-14 |