| NPI | 1770154577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 141604) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9473459) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2023-01-10 |