| NPI | 1417350455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9384089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9384089) |
| Enumeration Date | 2014-10-05 |
| Last Update Date | 2016-02-10 |