| NPI | 1003450271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11005416) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9383384) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2020-01-04 |