| NPI | 1295825107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1109132) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4052346) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IA D151650) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4052346) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28186878A) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2026-02-03 |