| NPI | 1124256656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 70552) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168356) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101194) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-03-09 |