| NPI | 1265833867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 679748-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 294429) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2020-12-15 |