| NPI | 1417423773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002086) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9415082) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 124300) | |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2021-09-02 |