| NPI | 1538682919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 738689) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005352) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 116973) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2021-03-02 |