| NPI | 1720040033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN241970) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 511014) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2018-03-17 |