| NPI | 1275243610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 40911) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AL 1-181729) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2026-01-23 |