| NPI | 1811236128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 567939) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 567939-1) |
| 163W00000X Registered Nurse (Licence: NJ 26NR14782900) | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2021-04-12 |