| NPI | 1801146451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 654839) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2283514) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 192547-30) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2021-11-14 |