| NPI | 1992451165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11032792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9495080) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-02-26 |
| Last Update Date | 2024-05-30 |