| NPI | 1457945131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11010763) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 135776) |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2025-11-24 |