| NPI | 1295470706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 137956) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R1765165) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10949) | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2023-11-22 |