| NPI | 1609582568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192350) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VA B201400360) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001277821) | |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2025-01-22 |