| NPI | 1013457035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 115436) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D185551) |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2025-10-30 |