| NPI | 1689303950 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1054180) | 
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R235866) | 
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CO Rn.1678435) | |
| Enumeration Date | 2022-06-09 | 
| Last Update Date | 2025-07-31 |