| NPI | 1780362855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ND R41495) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 203412) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-10-27 |