| NPI | 1750366274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 162885) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 520570-1) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2023-09-07 |