| NPI | 1699189696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 645070) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306905) |
| 363L00000X Nurse Practitioner (Licence: NY 306905) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-12-16 |