| NPI | 1063083855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1149842) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 861659) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2024-01-18 |