| NPI | 1043967706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11033816) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9550961) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9550961) | |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2024-09-09 |