| NPI | 1285499772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 148755) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 013332) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2025-11-07 |