| NPI | 1619803129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 797936-01) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 797936-01) |
| Enumeration Date | 2026-06-22 |
| Last Update Date | 2026-06-22 |