| NPI | 1568694941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9361535) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9361535) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9361535) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2021-08-20 |