| NPI | 1780109579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 611533) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 119568) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2023-03-09 |