| NPI | 1972060283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 133988) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 661135) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2021-01-15 |