| NPI | 1588034201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 595130) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25273) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 595130) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209019596) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2026-06-25 |