| NPI | 1922656354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005964) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL RN9283621) |
| 363L00000X Nurse Practitioner (Licence: FL 11005964) | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2022-04-11 |