| NPI | 1982206165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 710681) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 710681) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 132301) | |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2021-03-05 |