| NPI | 1124733555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002412) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MA RN2351699) |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2024-08-14 |