| NPI | 1093532152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 675301-01) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 147036) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-11-06 |