| NPI | 1063100105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 712298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN727376) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-03-17 |