| NPI | 1265274856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4025930) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KY 1150441) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-08-14 |