| NPI | 1801425947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 665623-01) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 665623-1) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2022-02-02 |