| NPI | 1962499954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 054081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 533659) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2017-01-23 |