| NPI | 1770950099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 705919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GU RE2128) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GU NP0155) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2016-12-06 |