| NPI | 1558901702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 227578) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 782960) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2022-12-29 |