| NPI | 1609497346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9385003) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11019743) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2022-07-13 |