| NPI | 1265955363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 604621-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 118587) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-11-17 |