| NPI | 1396126918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN608191) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 681883) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-05-03 |