| NPI | 1386169142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001766) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 518087) |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2022-09-23 |