| NPI | 1598277204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 119571) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 666968-1) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2021-07-16 |