| NPI | 1932531860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11011870) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 2262453) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2024-11-07 |