| NPI | 1982631420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 523744) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 598429) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-05-22 |