| NPI | 1457925158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 638707) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 638707) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-08-01 |