| NPI | 1003527839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA APRN-CRNA296139) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN296139) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2026-02-13 |