| NPI | 1952140790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 151336) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 674998) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-10-29 |