| NPI | 1538571799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9384865) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 573032) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 105943) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2025-05-29 |