| NPI | 1508344540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 891414) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 811107) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2026-03-27 |