| NPI | 1912405994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 644846) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 644846) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2024-12-20 |