| NPI | 1770339301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11040049) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9585805) |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2025-06-09 |