| NPI | 1235695560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 674351-01) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 087767-23) |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-01-09 |