| NPI | 1477075158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000742) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 112223) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2017-07-13 |