| NPI | 1003548637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11021888) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL APRN11021888) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2024-11-26 |