| NPI | 1578303111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR001189) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SD R042354) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-07-29 |