| NPI | 1972007540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11016887) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0224189489) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22009) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-05-07 |