| NPI | 1912203514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11033077) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 103439) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 17517) | |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2024-07-30 |