| NPI | 1235690868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11003013) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9292879) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10879) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2022-02-25 |