| NPI | 1720009707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1134101) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11013776) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA002275) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2024-05-10 |