| NPI | 1619505203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019962) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL RN9361859) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2022-06-08 |