| NPI | 1235679481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 639761-1) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 639761) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2026-03-10 |