| NPI | 1053077701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017743) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL rn9464287) |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2024-08-12 |