| NPI | 1457857013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 749005) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP145428) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 112620) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-03-16 |