| NPI | 1780364810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN110331106) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019003066) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2024-06-02 |