| NPI | 1619365665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL aprn11016365) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN213527) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN641843) | |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2025-07-09 |