| NPI | 1821631003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 129283) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 648534) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 648534) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2020-08-31 |