| NPI | 1073274130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017256) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 715815) |
| Enumeration Date | 2021-12-31 |
| Last Update Date | 2024-04-26 |