| NPI | 1073769444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 514256) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F430655-1) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2016-12-30 |