| NPI | 1013685619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31093) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KS 138266) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2022-02-02 |