| NPI | 1225673619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 290083) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 704594) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 129275) | |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2024-01-09 |