| NPI | 1992120182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9389635) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 201618) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2015-08-24 |