| NPI | 1215652375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 75374) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ID 44136) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2023-02-06 |