| NPI | 1447637483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 9689) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 128140) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2022-06-01 |