| NPI | 1770961823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9265131) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9265131) |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2018-02-07 |