| NPI | 1528485638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5049) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 564392) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2025-02-13 |