| NPI | 1821668369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11021843) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 317058) |
| 163W00000X Registered Nurse (Licence: FL RN9610604) | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2022-09-21 |