| NPI | 1962132225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 154931) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 723104) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 723104) | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-07-23 |