| NPI | 1255772240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5875) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 599888-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 304183) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2021-08-12 |