| NPI | 1548682479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11024846) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3008455) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008455) | |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2024-03-01 |