| NPI | 1134626708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11012365) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2307691) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2307691) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-07-28 |