| NPI | 1578285508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 257148) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 40860) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2026-01-15 |