| NPI | 1972155315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11022101) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN682851) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 123275) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-03-29 |