| NPI | 1558014787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017918) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9552850) |
| 163W00000X Registered Nurse (Licence: NY 712031-01) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11017918) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 712031-01) | |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2022-10-17 |