| NPI | 1588901086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R190088) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 572524-1) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2018-11-15 |