| NPI | 1083499701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 308880) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AZ 308880) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95418374) | |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2026-06-11 |