| NPI | 1710707252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61655838) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 10197706-3102) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2025-02-07 |