| NPI | 1124733076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R49249) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ND R49249) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-06-23 |