| NPI | 1063096386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25048) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: SC 211694) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-12-30 |