| NPI | 1891394490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 135365) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 712270) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2023-07-03 |