| NPI | 1689912990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 92494) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9278955) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP9278955) | |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2023-02-15 |