| NPI | 1922678820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024191721) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 286339) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7204) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2024-11-04 |