| NPI | 1750713467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK NURR36126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK NURR36126) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NJ 26NR13968700) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2021-03-17 |