| NPI | 1700641776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11031880) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9420938) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-03-22 |