| NPI | 1669047130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2347529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 728812) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 12050) | |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2025-12-01 |