| NPI | 1013776004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 663607) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 148172) |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-10-13 |