| NPI | 1811588619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R218550) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 839138) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2023-07-17 |