| NPI | 1326411331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 20225) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SC 108309) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2022-01-26 |