| NPI | 1013769462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 148196) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 685640) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-08-21 |