| NPI | 1962141044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11020817) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL 9413251) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-07-19 |