| NPI | 1316394869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9474204) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 105546) |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2020-11-17 |