| NPI | 1356662050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11040029) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 563867) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-08-01 |