| NPI | 1588306682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 717834) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 717834) |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2023-07-22 |