| NPI | 1700458866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 726268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA 726268) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 692570-01) | |
| 163W00000X Registered Nurse (Licence: NY 692570-01) | |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2022-05-24 |