| NPI | 1528658234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024180861) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: VA 0001254075) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2021-01-26 |