| NPI | 1205314630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101-0134566) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VT 026.0039991) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2322402) | |
| Enumeration Date | 2018-07-28 |
| Last Update Date | 2024-05-13 |