| NPI | 1326255449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA 129967) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D129967) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2024-01-11 |