| NPI | 1386331254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 729479) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 143055) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-08-02 |