| NPI | 1578015301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 689281) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 112521-23) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2024-12-04 |