| NPI | 1962072918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 144981) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 289166) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 870966) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95329745) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-10-09 |