| NPI | 1043610520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9430694) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 168728) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2020-12-17 |