| NPI | 1265646301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 5213511) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 521351) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-07-05 |