| NPI | 1801278940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24281) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 700304) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2024-09-23 |