| NPI | 1124779731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 137073) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 754700) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-04-16 |