| NPI | 1508588120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11026352) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9460794) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-05-25 |