| NPI | 1861842890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 111622) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 789658) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2020-11-18 |