| NPI | 1083120943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9489017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.375278) |
| 163W00000X Registered Nurse (Licence: FL RN9489017) | |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2023-06-08 |