| NPI | 1720745763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35445) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA 278662) |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2024-01-31 |