| NPI | 1598240004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11000996) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL 9362832) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2019-01-22 |