| NPI | 1700157443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11004274) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11004274) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN180374) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2024-01-25 |