| NPI | 1487259537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3015871) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28898) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 211520) | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2024-10-31 |