| NPI | 1922390210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169375) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9431447) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2025-02-19 |