| NPI | 1982277877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 149418) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 177484) |
| 163W00000X Registered Nurse (Licence: NY 632595) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2025-08-22 |