| NPI | 1275863623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 561255-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 561255) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2278195) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0083675) | |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2019-06-13 |