| NPI | 1609499854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11007155) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11007155) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2024-04-15 |