| NPI | 1902559008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11034593) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31820) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2024-12-05 |