| NPI | 1750053351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D168676) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 712697) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 712697) | |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2023-11-02 |