| NPI | 1578228326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11017075) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DC APRN11017075) |
| Enumeration Date | 2021-11-07 |
| Last Update Date | 2023-04-20 |