| NPI | 1871398230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL APRN11039747) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL RN9441278) |
| Enumeration Date | 2025-02-18 |
| Last Update Date | 2025-05-27 |