| NPI | 1700457959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 149453) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 63774) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-03-15 |