| NPI | 1902535271 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R239485) | 
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R239485) | 
| 163W00000X Registered Nurse (Licence: MD R239485) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024195106) | |
| Enumeration Date | 2022-06-10 | 
| Last Update Date | 2025-10-27 |