| NPI | 1942972971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017895) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9520231) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-05-23 |