| NPI | 1649035197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11040200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9511630) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2025-06-27 |