| NPI | 1487118840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 762495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 762495-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1101511) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2023-03-16 |