| NPI | 1528047750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2343750) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 663580) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 147503) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2020-08-06 |