| NPI | 1659912210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 223294) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN279065) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2023-02-06 |