| NPI | 1700514577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 149264) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11032799) |
| 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: FL 9423147) | |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2024-05-28 |