| NPI | 1982446936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11039883) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9536674) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-06-02 |