| NPI | 1871971267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2299879) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 664317) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041.510021) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-11-14 |