| 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 |