| NPI | 1902035702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP1867212) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 3511411) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-07-14 |