| NPI | 1407361322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8219) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 9463225-3102) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2023-08-15 |