| NPI | 1215511605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11020047) |
| Additional Taxonomies | 163WS0200X Registered Nurse School (Licence: FL RN9427667) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2022-06-14 |