| NPI | 1356913594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 696428) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 289834) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2024-08-29 |