| NPI | 1881409852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2025033120) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2017025432) |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-08-11 |