| NPI | 1669931895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9355046) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-05-20 |