| NPI | 1407215841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 576656-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 576656) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 576656) | |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2018-02-12 |