| NPI | 1871069971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 651043) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000991) |
| 163W00000X Registered Nurse (Licence: NY 651043) | |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2023-10-08 |