| NPI | 1679042600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11000863) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9344156) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2021-03-30 |