| NPI | 1205415320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11026479) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9463014) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2023-08-14 |