| NPI | 1386131852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012218) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005291) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2022-01-03 |