| NPI | 1770737611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 543496) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 081117) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2011-03-16 |