| NPI | 1174937304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9467663) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 608702) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 608702) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2021-11-17 |