| NPI | 1124797824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31014) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 222975) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2022-03-25 |