| NPI | 1417303702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 302091) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 302091) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2023-07-07 |