| NPI | 1609472158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 820830) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019011886) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-07-23 |