| NPI | 1346707593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 128211) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431661) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 682890) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-03-21 |