| NPI | 1447871355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 681563) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 681563) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0020897) | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2023-12-20 |