| NPI | 1164691770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9343133) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 129713030) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 129713030) | |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2025-03-05 |