| NPI | 1356876718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95001107) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 749914) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2021-11-30 |