| NPI | 1770572596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 278947) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP105576) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP2647522) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2021-09-28 |