| NPI | 1871537647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9401374) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 761027) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810281) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 60164) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-04-09 |