| NPI | 1285227686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 696969) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 696969) |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2021-09-13 |