| NPI | 1326511395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11000864) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL RN9275537) |
| 207L00000X Anesthesiology (Licence: OK 0131254) | |
| 163W00000X Registered Nurse (Licence: FL RN9275537) | |
| 363L00000X Nurse Practitioner (Licence: FL RN9275537) | |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2024-03-04 |