| NPI | 1942900196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11024984) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4042553) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-08-12 |