| NPI | 1174204143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11030737) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9438912) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-03-15 |