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 |