| NPI | 1154694602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9338743) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R177483) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2023-09-27 |