| NPI | 1619539871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 083040-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 800933) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R187146) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 800933) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.022891) | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2023-07-17 |