| NPI | 1164093092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002166) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95317690) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: DC RN1043315) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2023-09-07 |