| NPI | 1124774393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 149257) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9419050) |
| Enumeration Date | 2022-02-26 |
| Last Update Date | 2024-06-13 |