| NPI | 1427613504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 314643) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 314643) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2023-07-17 |