| NPI | 1760159669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 708235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 708235) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2023-07-17 |