| NPI | 1164512356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 082016) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD r154012) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 533128-1) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-12-21 |