| NPI | 1801637335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11033166) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 11033166) |
| 363L00000X Nurse Practitioner (Licence: FL 11033166) | |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-11-15 |