| NPI | 1053596726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9460880) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1101423) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2022-10-17 |