| NPI | 1093259822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9451487) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 2108) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2018-03-17 |