| NPI | 1720033764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 635864) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 126000) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-03-07 |