| NPI | 1821806241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 121760) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 101171) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2025-01-10 |