| NPI | 1982433652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4041128) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KY 20190043) |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2025-05-24 |