| NPI | 1689366585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 908661) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001306288) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-03-14 |