| NPI | 1508534538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 147178) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM 77111) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 0000249710) | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-01-02 |