| NPI | 1477802916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN562733) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 660178) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2024-09-11 |