| NPI | 1801444807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005404) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9349109) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 091032-23) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 322559) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2025-10-28 |