| NPI | 1457989048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11013649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9366449) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2023-09-21 |