| NPI | 1306368295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 730714) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 730714) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2024-11-01 |