| NPI | 1861483042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP 9199001) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 194828) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2009-07-20 |