| NPI | 1013525492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11014187) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 293624) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 293624) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2022-09-26 |