| NPI | 1215575444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 128442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 676671-1) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2020-03-06 |