| NPI | 1225661622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11013117) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 135494) |
| 163W00000X Registered Nurse (Licence: FL 9564462) | |
| 163W00000X Registered Nurse (Licence: NY 815139) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 135494) | |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2024-06-12 |