| NPI | 1114492592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 125634) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 125634) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2023-01-05 |