| NPI | 1477875144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017454) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA28265) |
| 163W00000X Registered Nurse (Licence: FL RN9391642) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2022-01-12 |