| NPI | 1992116826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 294058) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 294058) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2023-07-17 |