| NPI | 1649888348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11011434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9364508) |
| Enumeration Date | 2020-07-19 |
| Last Update Date | 2022-01-19 |