| NPI | 1851778005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 103691) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 576032) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-03-16 |