| NPI | 1144697327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 718592) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 137761) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2026-01-15 |