| NPI | 1396202933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11001891) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 3086) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2019-05-17 |