| NPI | 1205250842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3016592) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9307967) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 25800) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9307967) | |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2025-07-17 |