| NPI | 1912329780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11018225) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL APRN11018225) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2022-08-18 |