| NPI | 1932350667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11013726) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02722) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2021-07-22 |