| NPI | 1235760810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11023934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN258738) |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2023-11-17 |