| NPI | 1407454408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11010676) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9414750) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 15692) | |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2024-10-17 |