| NPI | 1407901234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NY 266121) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MS 19009) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 266121) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-07-07 |