| NPI | 1750889853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 623654) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 746306) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2023-07-03 |