| NPI | 1184354482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024190482) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: VA 0001243483) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-09-02 |