| NPI | 1003605551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14950) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CT 143363) |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-08-29 |