| NPI | 1871948539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 8205) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 568659) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2025-02-12 |