| NPI | 1801892641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 257003) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 395603) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2021-05-15 |