| NPI | 1023477544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9340893) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 110080) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2019-12-12 |