| NPI | 1093784522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9184768) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 090007-23) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-05-16 |