| NPI | 1912662800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11016620) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11016620) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 003748) | |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2023-09-28 |