| NPI | 1629535638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9363458) |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-06-25 |