| NPI | 1578228995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 733004) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 733004) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |