| NPI | 1902552193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11032713) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9502638) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2024-10-09 |