| NPI | 1396202453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 133989) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 659771) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-09-19 |