| NPI | 1477899193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 591714) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 591714) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2023-07-17 |