| NPI | 1548976954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192336) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: VA E202204899) |
| 163W00000X Registered Nurse (Licence: VA 1314227) | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2025-02-18 |