| NPI | 1568949675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 2300220) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 219493) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2020-10-13 |