| NPI | 1083623599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 657645) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI APRN-714) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 1922) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 746019) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-10-08 |