| NPI | 1447970983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11023718) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL STUDENT) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2023-03-15 |