| NPI | 1669892154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9315528) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 289101) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2019-04-10 |