| NPI | 1992460117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11036844) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN152813) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2025-02-03 |