| NPI | 1174302806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL RN11028851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN49804) |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-10-10 |