| NPI | 1346878873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019697) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9367866) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2023-03-23 |