| NPI | 1962763417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 671819) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN570337) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR12321600) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2013-07-01 |