| NPI | 1225619752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 219942-30) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SC 246630) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-09-29 |