| NPI | 1780059311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024180909) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA 8048491) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: WV 86842) | |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: VA 0001235809) | |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2021-04-22 |