| NPI | 1386354777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 115510) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 98303) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA rn670587) | |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2023-06-04 |