| NPI | 1053021436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2025053726) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2019035043) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2026-01-12 |