| NPI | 1619485281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F431347-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 652027) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 652027) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 652027-01) | |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2023-01-31 |