| NPI | 1336038207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 650404) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 650404) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-10-02 |