| NPI | 1700341062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11001636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9389621) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-04-13 |