| NPI | 1578140885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001551) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CA 95068965) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2022-06-10 |