| NPI | 1528702214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26135) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: SC 240022) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-07-06 |