| NPI | 1447906805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101695) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NE 69595) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D168599) | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-04-27 |