| NPI | 1164744702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9238252) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 303423) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2018-11-13 |