| NPI | 1669566634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 331587) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 331587-1) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-01-31 |