| NPI | 1619636883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11030608) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D184978) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2025-07-08 |