| NPI | 1235767039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11019619) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: FL 9525294) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2022-05-20 |