| NPI | 1093271405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11003491) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9388768) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2019-07-29 |