| NPI | 1902304520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 121625) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR17531800) |
| 163W00000X Registered Nurse (Licence: NY 627853) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2018-09-10 |