| NPI | 1518796754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002662) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 436625) |
| Enumeration Date | 2024-07-27 |
| Last Update Date | 2026-02-03 |