| NPI | 1831642834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11029830) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 112615) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2024-08-30 |