| NPI | 1184316028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11033367) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9470027) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-06-18 |