| NPI | 1649490285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN3102612) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 5362171) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-08-23 |