| NPI | 1003294265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 695210) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 077829-23) |
| 163W00000X Registered Nurse (Licence: NY 695210) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2025-11-03 |