| NPI | 1982699922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D50153) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 153106) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2023-07-22 |