| NPI | 1942935721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 224798) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AR R101450) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2023-06-07 |