| NPI | 1215988191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 473315) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 4733151) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-03-04 |