| NPI | 1134824980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11026488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9451420) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 76568) | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-01-03 |