| NPI | 1972171304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017146) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: LA RN155779) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2024-01-03 |