| NPI | 1174937403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9285085) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9285085) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9285085) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9285085) | |
| Enumeration Date | 2014-06-14 |
| Last Update Date | 2020-03-12 |