| NPI | 1740829852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005633) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9345739) |
| 163W00000X Registered Nurse (Licence: FL APRN11005633) | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-01-24 |