| NPI | 1174892491 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9473832) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN330426) | 
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 742752) | |
| Enumeration Date | 2011-12-15 | 
| Last Update Date | 2025-07-29 |