| NPI | 1215974977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 394) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 73953) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-11-17 |