| NPI | 1508539735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 718581) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 149060) |
| Enumeration Date | 2021-07-25 |
| Last Update Date | 2025-12-22 |