| NPI | 1972173185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002301) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95159147) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-02-27 |