| NPI | 1639797095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 143850) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 695917) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 695917) | |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2022-10-11 |