| NPI | 1629713425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 10696) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CT 157108) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2022-06-30 |