| NPI | 1144500018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11018636) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 18087) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2024-04-18 |