| NPI | 1467954321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 661331-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 661331-1) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2022-11-07 |