| NPI | 1376580886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11031026) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 42413) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-03-01 |