| NPI | 1003479890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002803) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 198788) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2019-07-22 |