| NPI | 1437523958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901358) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MS R882067) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2026-09-18 |