| NPI | 1013974369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 824627) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61066966) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000228) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2022-06-20 |