| NPI | 1619623956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11033110) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9344078) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2024-06-01 |