| NPI | 1770126880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 686803) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 686803) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-07-21 |