| NPI | 1548594146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9295951) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 082474) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2024-10-14 |