| NPI | 1023593092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000997) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SD R041467) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2020-12-16 |