| NPI | 1659004463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186437) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 95052) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2025-12-02 |