| NPI | 1922246248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 524329) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 5780873) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2013-08-20 |