| NPI | 1063483014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9284421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN093683) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04626) | |
| Enumeration Date | 2006-01-29 |
| Last Update Date | 2009-12-04 |