| NPI | 1548830623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 685847-01) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 009820) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT STUDENT) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-09-13 |