| NPI | 1982967527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 629382) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 082485) |
| 163W00000X Registered Nurse (Licence: NY 629382) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2018-10-24 |