| NPI | 1982304770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 720076) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 142811) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |