| NPI | 1255574117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9432002) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 94402) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 216588) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2021-07-07 |