NPI | 1477899193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 591714) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 591714) |
Enumeration Date | 2012-12-28 |
Last Update Date | 2023-07-17 |