| NPI | 1609644731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 745390-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 148191) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14884) | |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2025-11-14 |