| NPI | 1003562489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 137903) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 648718) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2024-09-08 |