| NPI | 1801489166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11013260) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9433360) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 32611) | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2022-12-23 |