| NPI | 1093282279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 839415) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11000815) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2023-03-16 |