| NPI | 1982012068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019464) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 19464) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2023-07-22 |