| NPI | 1245775717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2305776) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 112030) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2020-11-25 |