| NPI | 1871602599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 4187621) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 418762) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-07-05 |