| NPI | 1104136266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2268875) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 509973) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 509973-1) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2023-07-06 |