| NPI | 1194004101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9190051) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME AA113021) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2013001549) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2016-05-16 |