| NPI | 1275289092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11032868) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9460384) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2024-05-23 |