| NPI | 1649924689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019545) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9330776) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2023-02-06 |