| NPI | 1194892364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 345096) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 615) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2016-05-11 |