| NPI | 1336612431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 710483-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 125399) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2020-03-25 |