| NPI | 1619427887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9327212) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9327212) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2025-07-14 |