| NPI | 1700606910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192316) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001328446) |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2025-01-15 |