| NPI | 1437924289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9368823) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN784485) |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2026-06-29 |