| NPI | 1093193633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172642) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024172642) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 1262126) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2026-02-13 |