| NPI | 1306376249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 697339) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 697339) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-10-25 |