| NPI | 1912464215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 130185) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 690474) |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2020-10-18 |