| NPI | 1821147166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 4715031) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 471503) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-07-17 |