| NPI | 1639555683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9347119) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 7101) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2023-05-03 |