| NPI | 1235611096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11037295) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 687648) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2025-10-31 |