| NPI | 1790303584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11011224) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9389567) |
| 163W00000X Registered Nurse (Licence: FL RN9389567) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2021-02-22 |