| NPI | 1053058610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11023879) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9453452) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11023879) | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2023-10-08 |