| NPI | 1932746484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2362463) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 782229-01) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 782229) | |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-06-08 |