| NPI | 1720765829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192652) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001308409) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2025-08-25 |