| NPI | 1538050471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 794779) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 156046) |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-09-30 |