| NPI | 1356071450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024193923) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: DC RN1032747) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-07-28 |