| NPI | 1457096257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 691423) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 137558) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2022-05-05 |