| NPI | 1245892322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11022055) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 206906) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1001993) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-02-23 |