| NPI | 1215494778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9277136) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9277136) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL arnp9277136) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2021-02-19 |