| NPI | 1295249183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN702162) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 667346) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2020-05-29 |