| NPI | 1629786801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10046885) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 202010952RN) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2025-07-16 |