| NPI | 1447817903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11002414) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 126412) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-08-18 |