| NPI | 1073342812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 744459) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 157976) |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2026-08-26 |