| NPI | 1619281243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 598028) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 598028-1) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2024-12-24 |