| NPI | 1366099319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 156669) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431608) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2026-01-22 |